Longitudinal Uric Acid Clearance in Patients with Type 1 Diabetes and Preserved Glomerular Filtration Rate — ASN Events
  1. Schedule
  2. ADS Clinical Orals: Kidney Function in Diabetes
  3. Longitudinal Uric Acid Clearance in Patients with Type 1 Diabetes and Preserved Glomerular Filtration Rate

Longitudinal Uric Acid Clearance in Patients with Type 1 Diabetes and Preserved Glomerular Filtration Rate (#196)

Nicholas Radcliffe 1 2 , Michele Clarke 3 , Richard J MacIsaac 2 4 , George Jerums 2 3 , Elif I Ekinci 2 3
  1. Austin Clinical School, Austin Health, Heidelberg (Melbourne), Victoria, , Australia
  2. Department of Medicine, The University of Melbourne, Parkville (Melbourne), Victoria,, Australia
  3. Austin Health Endocrine Centre, Austin Health, Heidelberg (Melbourne), Victoria,, Australia
  4. Department of Endocrinology & Diabetes, St Vincent’s Hospital, Melbourne, Victoria, Australia

INTRODUCTION: Hyperuricemia may be an independent risk factor for the development diabetic kidney disease, however, the pattern and significance of uric acid clearance (CUr) in Type 1 Diabetes (T1DM) is currently not well understood. Cross-sectional data suggest increased CUr (and relative hypouricemia) may be common in T1DM with preserved renal function[1], however longitudinal data is lacking. Conversely, CUr appears to be reduced in established Diabetic Kidney Disease (eGFR <60ml/min/1.73m2)[2].

OBJECTIVES: To determine the relationships between longitudinal uric acid clearance (CUr), uric acid serum concentration (SUr), and creatinine clearance (CCr) in patients with type 1 diabetes (T1DM) and preserved renal function. Further, to compare baseline and longitudinal CUr changes based on rate of measured Glomerular Filtration Rate (mGFR) decline.

METHODS: Percentage annual change from baseline (determined by least squares linear regression) was assessed for each of CUr (ml/min/1.73m2) SUr (mmol/L) and CCr (ml/min/1.73m2) in 61 patients with T1DM. CUr baseline and absolute rate of change (again from linear regression) was compared in patients with rapid (≥5mL/min/1.73m2/year)versus non rapid (<5mL/min/1.73m2/year ) decline in mGFR using Wilcoxon rank-sum testing. mGRF was calculated from plasma clearance of diethylene-triamine-penta-acetic acid.

RESULTS: Baseline median mGFR was 95ml/min/1.73m2 (IQR: 82-111ml/min/1.73m2). Median number of CUr/SUr/CCr measurements per patient was 5 (IQR: 4-6), and median followup was 4.1 years (IQR: 3.2-5.1). Overall baseline CUr was 4.59ml/min/1.73m2 (median, IQR: 2.62-7.59) and rate of change was +0.56mL/min/1.73m2/year (p<0.001, 95%C.I. 0.32-0.81). Figure 1 presents percentage change from baseline in each of CUr, SUr andCCr, extrapolated graphically for 5 years. No statistically significant differences in baseline or rate of change in CUr were noted between those with rapid mGFR decline (n=13) and non-rapid mGFR decline (n=47).

CONCLUSION: Uric acid clearance increased significantly in patients with T1DM and preserved baseline kidney function, despite a fall in creatinine clearance. Baseline or longitudinal changes in uric acid clearance were not different between those with and without rapid renal function decline. Further studies with longer follow-up may be necessary to determine the renal prognosis associated with changes in uric acid handling.

2219-Figure1UrateADS.png

  1. [1] Esparza Martin N, Garcia Nieto V (2011) Hypouricemia and tubular transport of uric acid. Nefrologia 31: 44-50
  2. [2] Li L-X, Wang A-P, Zhang R, et al. (2015) Decreased urine uric acid excretion is an independent risk factor for chronic kidney disease but not for carotid atherosclerosis in hospital-based patients with type 2 diabetes: a cross-sectional study. Cardiovascular Diabetology 14: 36